Hospital policies and practices on prevention and treatment of infections caused by methicillin-resistant Staphylococcus aureus

Abstract

Purpose: The use of policies and practices regarding surveillance, decolonization, and treatment of methicillin-resistant Staphylococcus aureus (MRSA) infections and the formulary status of various antimicrobial agents used to treat MRSA were characterized.

Methods: A 61-item questionnaire was sent to the director of pharmacy at each of 263 acute care hospitals that were members of a national group purchasing organization.

Results: Responses were received from 102 hospitals (38.8%). Active surveillance culture protocols were in place at 44 hospitals (44%). Nearly 75% engaged in key antimicrobial stewardship activities, while only 18% reported having a formal antimicrobial stewardship team. MRSA decolonization policies existed in approximately 25% of the respondent hospitals. Vancomycin was on the formulary in all hospitals with few restriction policies, while the newer anti-MRSA agents-linezolid, daptomycin, and tigecycline-were on the formulary in most hospitals but with restrictions. Vancomycin was the most commonly used antimicrobial for the treatment of various MRSA infections, followed by linezolid. Nearly 70% of the respondent hospitals reported having a vancomycinspecific dosing or monitoring guideline in place. Most specified the use of actual body weight for dosing and trough serum concentrations at steady state for therapeutic monitoring (84% and 91%, respectively). Most guidelines did not address the use of a loading dose to attain a high target trough or methods for choosing alternative agents.

Conclusion: Acute care hospitals in the United States varied in their policies and practices of surveillance, decolonization, and treatment of MRSA infections, but most were consistent with national guideline recommendations.